Objective To compare the effect of anterior internal fixation and posterior pedicle screw fixa-tion in the treatment of lumbar burst fractures.Methods Thirty-three patients( the anterior group) with burst frac-ture of lumbar spine treated by anterior internal fixation system in our hospital from Feb.2012 to Dec.2013 were se-lected.Fifty-four patients ( the posterior group) treated by posterior pedicle screw rod system fixation were also ret-rospectively analyzed.The differences in operation time, intraoperative blood loss,loss of Cobb' s angle,Japanese Orthopaedic Association ( JOA) Scores,anterior height ratio of the vertebral body and score by American Spinal In-jury Association (ASIA) between the two groups were compared.Results The operation time of (178.8 ±55.2) min and the intraoperative blood loss of ( 750.9 ± 85.2 ) mL in the anterior group were both significantly higher than those of the posterior group[(149.3 ±38.6)min,(414.3 ±67.8)mL] and the difference was statistically sig-nificant(P<0.05).One year after surgery,Cobb's angle in the posterior group was (9.6 ±2.4)°and the loss of Cobb's angle was (6.1 ±1.9)°,significantly higher than those [(4.5 ±1.9) °,(0.8 ±0.3)°,P<0.05] in the anterior group.JOA scores before operation in the two groups had no statistical significance(P>0.05).After 1 year of operation,the JOA scores of the two groups were significantly improved and the difference was statistically significant(P<0.05).After 1 year of operation,the height ratio of anterior vertebral body height was significantly improved in the two groups(P<0.05).Difference in postoperative ASIA scores between the two groups had no sta-tistical significance( P>0.05) .Conclusion The results of the two methods in the treatment of lumbar burst frac-ture are both satisfactory.The disadvantage of the posterior group is the large loss of Cobb angle correction and the disadvantage of the anterior group is the surgical trauma.Individualized consideration should be given to the factors such as patients' surgical tolerance.%目的 研究对比脊柱前路内固定器系统内固定及脊柱后路椎弓根钉棒系统内固定治疗腰椎爆裂性骨折的效果差异.方法 笔者选取2012年2月~2013年12月采用前路内固定器系统内固定治疗的33例腰椎爆裂性骨折患者(前路组)、后路椎弓根钉棒系统内固定治疗的54例患者(后路组)进行回顾性分析,对比两组患者的手术时间、术中出血量、Cobb角丢失、日本矫形外科协会(JOA)评分、椎体前缘高度比值以及美国脊柱损伤协会(ASIA)分级等指标的差异.结果 前路组的手术时间[(178.8±55.2)min]、术中出血量[(750.9±85.2)mL]均显著高于后路组的手术时间[(149.3±38.6)min]、术中出血量[(414.3±67.8)mL],且差异具有统计学意义(P<0.05).术后1年后路组的Cobb角(9.6±2.4)°、Cobb角丢失(6.1±1.9)°均显著大于前路组患者的(4.5±1.9)°、(0.8±0.3)°(P<0.05).术前、术后两组患者的JOA评分组间比较差异均无统计学意义(P>0.05),术后1年两组患者的JOA评分较术前均显著提高且差异具有统计学意义(P<0.05);术后1年两组患者的椎体前缘高度比值较术前均显著提高(P<0.05);两组间术后的ASIA分级差异无统计学意义(P>0.05).结论 两种方法治疗腰椎爆裂性骨折的效果均较好,前路组的缺点是手术创伤大,后路组的缺点是术后Cobb角矫正丢失度大,因此应该根据患者的手术耐受力等因素进行个体化考虑.
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